Causes of Eating Disorders - another angle

I'm still reading The Emperor of All Maladies.   The subject - cancer - has nothing to do with eating disorders but the science so well presented as a backdrop to the progress against cancer has been absolutely fascinating and a great help to understanding how researchers go about identifying how genes play a major part in the susceptibility to different kinds of cancer as well as the treatment of different types of cancer.

After years of reading studies and books, participating in family groups, listening to speakers at conferences, etc., rather than becoming an advocate of one method or another, I've become more convinced that eating disorders, while related to eating (or not), are different just as breast cancer is different from lung cancer is differed from colon cancer. 

Last fall, after attending the NEDA convention in New York City, I mused that perhaps the term eating disorder is a misnomer and in fact should be called 5-HT disorders.  The work of Dr. Walter Kaye and others certainly points to the probability of anorexia and bulimia being psychobiological illnesses.  Anxiety and methods to quell it are certainly part of the picture.  But perhaps there's even a more basic explanation for the underlying development of eating disorders.

The study that Carrie Arnold highlighted recently explores this idea.  Dr. Donald Dwyer has proposed that anorexia is "primarily a metabolic disorder caused by defective regulation of the starvation response, which leads to ambivalence towards food, decreased food consumption and characteristic psychopathology."

I'm excited by this study because someone has stepped out of the box and looked at anorexia in a different way. 

Suppose all of the disorders within the title "eating disorders" are indeed endocrine based and that each person's endocrine/neurophysiology (I am sure there's a scientific term that would encompass this) is affected by their genome.  If the reader clicks on each of the areas of the body listed in this linked definition, one will see the number of different biochemicals secreted and how they are postulated to affect the body/brain in some way.  I find my mind boggled by all the interrelationships and in awe of my body's ability to stay in balance (reasonably, anyway).

Looking back over my musings these last few months and drawing from, admittedly, a very small cohort of two people who are members of a family that has demonstrated issues with eating over the years, I'd like to reiterate a couple of other thoughts that might be related to the endocrine system and tie into Dr. Dwyer's research.

I and my daughter both began our eating disorder journey with bulimia when we were in high school, about the same age, and having entered puberty about the same time.  Both of us progressed to anorexia within a couple of years, she more entrenched than I ever became.  Two other family members struggled with binging; one still does.  Many in our family have also dealt with depression and anxiety.

Interestingly, and I'm really curious about this and how prevalent it might be in the general population of those with anorexia, both my daughter and I also failed to thrive while being breastfed.  My mother and then I needed to gently flick our baby's heel to get us to wake up and continue to eat.   In an earlier piece I've written about oxytocin and how this hormone, present in breast milk, can cause a baby to drowse off without satisfying its need (not desire, but need) for enough food to maintain its weight and grow.    I do attribute my recovery partially to my decision to get massages which also trigger the release of oxytocin in my body.  Is oxytocin deficiency part of this picture?

After I met with Martie Fankhauser several months ago to learn more about nutrition, one of the things I learned is that there are also serotonin receptors in the intestines.  Interestingly, Harriet Brown wrote an article discussing this neurotransmitter and its presence in the gut (the body's second brain) in 2005 and how it is implicated in GI disorders.  Too much serotonin in the gut can lead to nausea and vomiting. Does puberty have something to do with this; or more specifically the hormones that flood adolescent systems?

So, I am asking myself is bulimia a separate illness caused by too much anxiety that leads to too much serotonin that leads to the propensity to vomit?    I also ask this question because I recently came across a disorder called Cyclic Vomiting Syndrome  and wondered if there is a connection since anxiety is one of the factors that seems to cause it.   Can bulimia then progress to anorexia once the endocrine system is knocked out of balance by the binging and purging that's common with this illness?  Bulimia certainly can become a habit - an addiction -  in and of itself, as well.

The literature and media has focused more and more on the prevalence of eating disorders in older women, as well.  Does perimenopause have something to do with this?  Hormones, again.  Do men also experience this but perhaps do not talk about it?

Finally, one must take a look at BED - binge eating disorder.  What causes a person to eat what others would consider "....an unusually large amount of food who also feels out of control while eating it?"  Dr. Cynthia Bulik is a well-known and major researcher within the field looking at eating disorders.  She has written the book Crave - What You Binge Eat and How to Stop.  One could postulate that even this eating disorder has an underlying endocrine system basis.  If anorexia, according to Dr. Dwyer, is the result of "a metabolic disorder caused by defective regulation of the starvation response" [see above for quote source], then why could not BED be due to another yet related metabolic disorder?

I hope we will soon begin to hear more about current research as scientists are collaborating and presenting more of their work.  We need more conferences that invite the different disciplines to present what they are uncovering about our neuro/psycholbiological systems. Twenty years (the time it used to take to get this kind of information to the patient and his/her team) is too long.